postpartum assessment

postpartum length time

6 weeks

how often to monitor vital signs right after delivery then rest of hospitalization

monitor frequently first 2-3 hours

then Q4 rest of time

unless complications need otherwise

vital signs postpartum

blood volume changes (loss of blood during birth) so orthostatic hypotension is common

HR is high

RR, temp and BP same/simular

abnormal BP

above 140/90

fifth vital sign

normal vitals: HR, RR, BP, temp

fifth: pain

pain treatment options PP

ibuprofen - 600 mg PO q6h

acetaminophen 650-1000 mg PO q4-6

oxycodone 5-10 mg PO q4-6

oxycodone is normally just for c sections unless bad tear during vaginal birth

OLDCARTS

onset

location

duration

characteristics

aggravating factors

relieving factors

treatments

severity

nonpharmacological interventions

sitz bath - warm water bath

for c section it helps to hold pillow over incision while moving bc it can feel like organs are falling out

sensory things like low light and low noise

abdominal binder

really bad period cramping feeling is caused by what

spike in oxytocin caused by breastfeeding

common causes of pain postpartum

contractions to help keep uterus cramped after delivery to keep mom from bleeding too much

lacerations with vaginal birth

after vaginal birth can have back and hip pain

what type of pain is concerning postpartumq

headache

what does BUBBLEEE stand for

used for postpartum assessment

breast

uterus

bladder bowels

lochia

episiotomy

extremities

emotions

prolactin

increased prolactin - milk production

prolactin levels slowly rise during pregnancy then will continue to rise after delivery

colostrum

densely packed with nutrients and fats

beginnings of breast milk - will change into typical breast milk in 2-4 days

engorgment

happens when breast feeding

breasts will become super swollen with milk, tender and firm

baby doesnt need all that breastmilk body is overproducing will subside with time as long as dont overpump

relieving factors - ice, cabbage leaves are good for inflammation

nursing responsibilities in regards to breast feeding

assess breastfeeding - should happen in first 30 minutes after birth bc then baby will go to sleep

assess breasts and nipples - look for skin and nipple impairment like cracks

patient education

supportive bra, nipple care (colostrum is good for sore nipples), relief for engorgement

nursing care for non-breastfeeding patients

assess breasts but avoid palpation

prolactin levels drop rapidly if do not stimulate nipples/breasts for 48-72 hrs

colostrum may be present - initial steps will still occur

patient education

still supportive bra, avoid nipple stimulation and milk expression, ice for engorgment

postpartum cardiovascular and respiratory changes

blood volume increases during pregnancy because body is expecting to lose blood during birth

postpartum chills due to dramatic fluid changes and hormones

postpartum edema due to fluid changes - can be monitored thru respiratory changes

QBL/EBL

quantified/estimated blood loss

average blood loss during birth

up to 500 ml for vaginal

up to 1000 ml for c section

nursing roles postpartum regarding cardiovascular and respiratory

assess hemoglobin and hematocrit (Hgb & Hct)

lower threshold for anemia for pp

anemia: Hgb < 11 and Hct < 32